Senior Account Executive

Role Overview: The primary responsibility of Account Executive Sr. is to develop strong relationships with providers to drive for performance specifically as it relates to core providers who are on risk-based or cost sharing VBC arrangements as well as large health system contracts.

Work Arrangement:

• Remote – This position is fully remote. The Associate must be located in Delaware (DE) to attend in office meeting as needed.

Responsibilities:

• Supports network development and network management strategies.
• Responsible for assisting the Leader with departmental activities related to provider satisfaction, education, and communication.
• Responsible for participating and implementing Provider Network education programs and materials (both internal and provider targeted) and is assigned to train, mentor and support new AE’s.
• Responsible for hospital and physician network development and management; including joint operating committees (JOC) for identified groups, oversight of necessary quality review meetings with targeted providers and/or health systems.
• Responsible for building, nurturing and maintaining positive working relationships between Plan and its contracted providers; including those that are most complex.
• Resolve Provider disputes in a timely and compliant manner.
• Responsibility for a higher number of multiple practice locations and multi-specialty practices and multiple providers. Should also include hospital systems, contracted subcontractors (DME, Vision, etc.), and ancillary providers.
• Develop/implement/manage programs and projects that support/impact high dollar and high member provider groups.
• Perform site visits as needed.
• Oversee resolution of provider issues managed by other Provider Network support teams.
• Take corrective actions required up to and including termination, following Plan policies and procedures.
• Operationalizes completed contracts with advanced complexity.
• Consults on VBC contracts, facilitates for success (JOCs, performance overview, etc.) with specific bonuses attached to performance improvement.
• Responsible to maintain and manage Value-Based contract requirements, including but not limited to; monitoring performance standards against VBC or State program requirements, working with key stakeholders and provide oversight on applicable data-sharing or report requirements.
• Responsible for hospital and physician network development and management; including joint operating committees (JOC) for identified groups, oversight of necessary quality review meetings with targeted providers and/or health systems.
• General Operational Knowledge related to provider satisfaction, education, and communication with a fundamental understanding of operational items such as claims, payment integrity, provider data, credentialing, appeals disputes etc.
• Support contracting for multiple product lines, including LTSS, Exchange, DSNP adequacy gaps (high complexity).
• Assist with recruiting providers based on identified network adequacy gaps (high complexity).
• Support of VBC negotiations; lead in VBC relationships; may lead negotiations.

Education & Experience:

• Associate’s degree
• 7 years of experience if no bachelor's degree.
• 5 or more years strong communication skills, financial acumen.
• Ability to have difficult conversations.

Licensure:

• Valid driver's license, care insurance, and reliable transportation.